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How many Americans have died due to fentanyl?
The answer depends on whether you want one recent-year snapshot or the running total over the quarter-century since the drug crisis began. Below is the most complete picture available from the U.S. Centers for Disease Control and Prevention (CDC), the agency that maintains the official mortality database.
What the CDC actually counts
• Fentanyl (both prescription and, today, overwhelmingly illicitly manufactured) is grouped with “synthetic opioids other than methadone” and coded T40.4 in death certificates.
• When medical examiners list more than one drug on a certificate, each is counted, so a single death can be tallied in several drug categories.
• Numbers for 1999-2021 are final; 2022-2023 are still provisional and may rise slightly after toxicology and coding are completed.
Annual deaths involving fentanyl (T40.4)
Final counts, CDC WONDER, ICD-10 code T40.4, accessed August 2023
2010 ……………… 3,007
2011 ……………… 2,666
2012 ……………… 3,007
2013 ……………… 3,105
2014 ……………… 5,544
2015 ……………… 9,580
2016 ……………… 19,413
2017 ……………… 28,466
2018 ……………… 31,335
2019 ……………… 36,359
2020 ……………… 56,516
2021 ……………… 70,601 (fentanyl now in >70 % of all U.S. overdose deaths)
Provisional counts, 12-months ending December:
2022 ……………… ~73,700
2023* ……………… ~74,000 (12-mo. ending April 2023; marked with * because still updating)
Cumulative toll
• 1999-2021 final: 344,592 deaths involving fentanyl or its analogues.
• Add provisional 2022: ≈73,700 more.
• Running total through 2022: roughly 418,000 American deaths.
• Include the first half of 2023 and the figure already exceeds 440,000.
Context and trends
• Scale of increase: From 730 deaths in 1999 to >70,000 per year today—a 100-fold rise.
• Share of all overdose deaths: 15 % in 2015 → about 70 % in 2021-2023.
• Illicit, not medical, fentanyl drives the epidemic; most deaths now involve counterfeit pills or powder often mixed with cocaine, methamphetamine, or heroin.
• The steepest single-year jump occurred between 2019 and 2020 (+20,000 deaths), largely coinciding with the COVID-19 pandemic’s social and healthcare disruptions.
Data limitations
• Under-counting is possible when toxicology panels are incomplete or when fentanyl analogues are not specifically identified.
• The T40.4 code does not separate pharmaceutical fentanyl from illicitly manufactured fentanyl.
• Because deaths can be recorded in multiple drug categories, fentanyl-involved deaths (above) cannot simply be added to heroin or methamphetamine numbers without double counting.
Bottom line
Roughly 70-75 thousand Americans are now dying each year from overdoses that involve fentanyl, and the running total since 1999 has already passed 400 thousand deaths—making fentanyl the deadliest drug in the modern history of the United States.